恶性腹膜间皮瘤26例临床分析

Clinical Analysis of 26 Cases of Malignant Peritoneal Mesothelioma

摘要: 目的：探讨恶性腹膜间皮瘤(malignant peritoneal mesothelioma, MPM)的临床特点、病理特征、治疗及预后。方法：选取2010年至2020年在青岛大学附属医院经病理确诊的26例腹膜恶性间皮瘤患者，收集其性别、年龄、临床表现、辅助检查、病理结果、治疗方式及预后等临床资料，回顾性分析并总结其临床、病理特点及疗效。结果：26例患者中位年龄59.5岁，男女比例1:1.89，仅1例具有石棉接触史。首发症状主要表现为腹痛、腹胀，肿瘤标记物以CA125升高为主，B超和CT检查可见腹水、腹膜增厚和腹盆腔肿块，大网膜呈“饼状”。26例均经病理确诊，组织学分型：上皮型9例，肉瘤型2例，未分型15例。免疫组化指标选择不完全相同，阳性率最高的依次为CK (100%)、CK7 (94.4%)、Vimentin (90.9%)、Calretinin (89.5%)、D2-40 (88.9%)、CK5/6 (88.2%)和WT-1 (81.3%)，检测CK20、CDX-2均为阴性。13例接受剖腹手术或腹腔镜手术联合全身化疗，8例接受单纯化疗，3例放弃治疗，失访2例。全部患者的中位无进展生存期(progression-free survival, PFS) 6个月，中位总生存期(overall survival, OS) 7个月。单因素生存分析显示，仅年龄的差异有统计学意义(P = 0.001, χ2 log-rank = 10.424)。结论：恶性腹膜间皮瘤临床表现无特异性，超声或CT引导下组织活检有助于诊断。恶性腹膜间皮瘤预后差，年龄影响其预后，手术和化疗不能有效延长患者生存期。

Abstract: Objective: To discuss the clinical characteristics, pathological characteristics, treatment and prognosis of malignant peritoneal mesothelioma. Methods: Select 26 patients with peritoneal malignant mesothelioma diagnosed pathologically in The Affiliated Hospital of Qingdao University from 2010 to 2020. Collect their gender, age, clinical manifestations, auxiliary examinations, pathological results, treatment methods and prognosis and other clinical data for retrospective analysis and summarize its clinical, pathological characteristics and efficacy. Results: The median age of the 26 patients was 59.5 years, the male to female ratio was 1:1.89, and only 1 patient had a history of asbestos exposure. Initial symptoms are mainly abdominal pain, bloating. The tumor markers were mainly elevated CA125. B-ultrasound and CT examination showed ascites, thickening of the peritoneum, abdominal and pelvic masses, and a “cake-like” appearance of the omentum. All 26 cases were diagnosed by pathology, histological classification: 9 cases of epithelial type, 2 cases of sarcoma type, and 15 cases of unclassified type. The selection of immunohistochemical indexes is not exactly the same. The highest positive rate is CK (100%), CK7 (94.4%), Vimentin (90.9%), Calretinin (89.5%), D2-40 (88.9%), CK5/6 (88.2%) and WT-1 (81.3%), the detection of CK20 and CDX-2 were all negative. 13 cases received laparotomy or laparoscopic surgery combined with systemic chemotherapy, 8 received chemotherapy alone, 3 gave up treatment, and 2 were lost to follow-up. The median progression-free survival (PFS) of all patients was 6 months, and the median overall survival (OS) was 7 months. Univariate survival analysis showed that only the difference in age was statistically significant (P = 0.001, χ2 log-rank = 10.424). Conclusion: The clinical manifestations of malignant peritoneal mesothelioma are not specific. Ultrasound or CT-guided tissue biopsy is helpful for diagnosis. Malignant peritoneal mesothelioma has a poor prognosis, and age affects its prognosis. Surgery and chemotherapy cannot effectively prolong the survival of patients.